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HIV Medicine 2017 Stephen Raffanti, M.D., M.P.H. Medical Director, VCCC Professor of Medicine VU HIV Medicine 2017 ▪ HIV pathogenesis and why we treat HIV infection; ▪ The challenges of treating a life-long chronic infection with toxic agents; ▪ How we put all the information together to make the best choice. ▪ ART Conference Case presentations ▪ Special Programs ▪ Future Challenges AIDS: Not Just Another Disease Stonewal l Riots 1969 1981 Three Decades of Treatment Issues ▪ 1980’s: AIDS described, PCP kills 90% of pts., clinicians develop skills in diagnosing, treating and preventing complications. ▪ 1990’s: First effective treatments, patients respond, death rates drop. ▪ 2000’s: New toxicities arise, resistance is critical, adherence issues emerge, limitations of therapy become apparent. ▪ 2007: Second round of effective antiretroviral agents-integrase and CCR5 inhibitors. ▪ 2013: Serious talk of “cure”. ▪ 2015: PREP Opportunistic Infections in HIV Disease The Face Of HIV care: 1981 through 1996 ▪ Endless procession of dying young people with no hope of treatment: ▪ Minimal lab technology; ▪ AIDS defining illnesses dominated; ▪ Wasting, dementia, KS, lymphoma, CMV; ▪ Limited number of toxic inefficient medications: ▪ Antiretrovirals: AZT, ddC and ddI ▪ OI treatments: antifungals, antivirals, anti-mycobacterials ▪ Heavy imprint of stigma; ▪ Hospice expertise. The Social Political Fabric of AIDS: 1982-1987 On December 10, On July 25,1983, San Francisco General 1982, CDC reports a Hospital opens the first dedicated AIDS case of AIDS in an ward in the U.S. It is fully occupied within infant who received days Civil Rights blood transfusions. Movement Ryan WhiteAct Up, an Indiana 1954 teenagerorganizes who contracted The following week, In January 1982Stonewall , first AIDS“Occupy through the MMWR reports 22 Riots contaminatedWall blood 1969 Street” cases of unexplained American AIDS clinic is products1987 used to treat immunodeficiency and his hemophilia, is refused opportunistic established in S.F.
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